AVP, Utilization Management

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Ensemble Health Partners

Site WebLinkedInTous les Emplois

5001 - 10000 employés

⚕️ Assurance santé

☁️ SaaS

🏢 Entreprise

💰 Private Equity Round en 2022-03

Healthcare Insurance • SaaS • Enterprise

Ensemble Health Partners est un leader dans la fourniture de services de gestion du cycle de revenus (RCM) pour les organisations de santé. Ils offrent une solution RCM de bout en bout qui aide les hôpitaux, les systèmes de santé et les groupes de médecins affiliés à optimiser leurs cycles de revenus, réduire les refus et les sous-paiements, et améliorer l'expérience des patients grâce à une combinaison de gestion experte et de technologie avancée. Ensemble Health Partners s'appuie sur des opérateurs certifiés et l'IA pour fournir des résultats constants, améliorer les recouvrements et soutenir la croissance future des prestataires de soins de santé. Ils sont reconnus pour leurs solides partenariats clients et leur engagement à offrir une augmentation fiable des revenus et des économies de coûts pour leurs clients.

Description

• Executes enterprise utilization management strategy aligned with organizational and regulatory requirements • Oversees operations including prior authorization, medical necessity review, and concurrent review processes • Ensures compliance with CMS, payer, and state regulatory requirements • Identifies and mitigates audit, compliance, and reimbursement risks • Monitors performance metrics including denial trends and utilization efficiency • Drives performance improvement initiatives based on data analysis • Collaborates with clinical, case management, and revenue cycle teams to improve documentation and reduce denials • Supports implementation and optimization of utilization management technologies and workflows • Leads and develops managers and operational leaders • Supports succession planning and organizational capability development • May be required to perform other job-related duties as requested.

🎯 Exigences

• Bachelor’s degree or equivalent combination of education and experience • Current RN license • 10+ years of relevant experience including advanced knowledge of utilization management and healthcare reimbursement • 5+ years of people leadership experience • Strong executive presence with the ability to project confidence, credibility and authority; able to remain calm & show decisiveness under pressure • Exhibits strong strategic and analytical skills with the ability to drive operational improvements • Ability to build and maintain relationships with key internal and external stakeholders • Ability to effectively lead diverse teams and influence change management in a complex healthcare operations environment • Effective communication skills with ability to clearly and succinctly convey information and ideas • Demonstrated advanced usage of AI, success in translating AI into Business outcomes, and the ability to move teams from experimentation to scale.

🏖️ Avantages

• Health insurance • Time off • Retirement plans • Well-being programs • Professional development opportunities